Loading...
HomeMy WebLinkAbout08-04-08J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg PA 17128-0601 RESIDENT DECEDENT ~' ~ ~ 'Z ~ ~ ~~ ENTER DECEDENT INFORMATION BELOW ~ ~ fj' Social Security Number Date of Death Date of Birth 1 ~3 -~ 3~-3a ~ga~a©o~ o~3if9 ~3 Decedent's Last Name Suffix Decedents First Name MI ~~ i ~LFr~ ~>R 4. L i ~ 1.~/ (If Applicable) Enter Surviving Spouse's Information Below Spotuse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Is 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~' 0 ~ N !~ IR- V ~S '~ ~ 7 ~ 7/ ~ ~ ~- ,~ . Firm Name (If Applicable) First line of address ~~ 1~-~ STEP ~ e~~S c Q~ s si ~~ Second line of address City or Post Office t~N,eC N ~~ i c S 4~ ~G Correspondent's a-mail address MI REGISTEI~F WILLS US~~ILY .. is ~ --A ~~n u3 '- -~~r- t I. r ~> ,.... i y.. _~;}_ -~ ._ ~~ ._, ; ,~; C ~_~ , -°~- _.~ .. DBE FILED ~~ ~:. State ZIP Code L P ~- ~ 7 0 ~o Under penalties of ry, I declare that I hav examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tine, correct a d co plete. clarati of eparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF RS N ONSI E FO FILING RETURN DATE &~ ADDRESS G ~ ~~ _ Q~ 1~ S- r ` SIGNATURE O EPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J REV-1500 EX 15056052048 Decedent's Social Security Number Decedent's Name: ` 1 RECAPITULATION 1 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses ~ Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. --~•~~ w ~^~ wn ~ JCC irv~ i,ci.,t, i ivrvs tUK APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable • at lineal rate X .0 _ 17. Amount of Line 14 taxable • at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 14. Net Value Subject to Tax (Line 12 minus Line 131. , 15. 16. 17. 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p /r~ • 1LOJ/ . ~• °1 V • ~~ ~~~'~, (8~~~~~i.~ ~ ~' ~~~~~ Side 2 15056052048 15056052048 REV-15o2 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER All real property owned sot y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF L I I EM NUMBER 1. FILE NUMBER ~e i 7 ~~e.~L. l0a¢,,(i'o . All property jointly-owned with right of survivorship must be disclosed on Schedule F. TOTAL (Also enter on line 2, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) r ~ a-~~ t ~~-s~~~•~ ~~ v m ~ ~ ~~a~ a- ~,~,`~`.~~lY S ~ t 4'" ~ ~ Sc ~~4'9 ~~ ~~ ~~- acv--~ ~C~ ~ ~ ~ ~ .~ ~s ~' ~~ ~~( r/" ° (, ~ ~~ e ~Q C `~,-Q, T - ~ C ~ ~(, ~--a ©wF Gli'~ ~ ~2/L E~--~- f-~ ~ ~ ~- ~~ ~~ 2~ ~-~~~~ ~ G~~ ~~ C ~ z~< i '~~`~~ ~~ ~ ~ ~~c ~ fit? c~ ~-~-v"~ t~,~~' ~9a C~-v''~c-~ ~ ~`Al ~ ~ ~' ~ y) -_~ 7- ~ 4~ VALUE AT DATE OF DEATH ~~ REV-1508 EX + i1-97) SCHEDULE C COMMpNWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE 4F " FILE NUMBER Schedule C-1 or C-2 (Including alt~supporGng information) must be attached for each closety-held corporationlpartnership interest of the decedent, otherthan asole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH /~/o tie ~~it/o~,.. n TOTAL (Also enter on fine 3, Recapitulation) ~ ; (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY HELD CORPORATE INHERITANCE TAX RETURN STOCK tNFORMATtON REPORT RESIDENT DECEDENT ESTATE QF ~ ~/F~ILE NUM~B`ER~,/~ ~j (~^ ~1 1. Name of Corporation ~ ,State on Incorporation Address Date of Incorporation City _ State Zip Co Total Number of Share Iders 2. Federal Employer I.D. Number Busi ess Reporting Ye r 3. Type of Business ProducU ervice 4' STOCK TYPE TAL N BER OF AR VALUE MB OF SHARES VALUE OF THE VotingfNon-Voting S ARES 0 STANDiN 0 ED B THE DECED T DECEDENT'S STOCK Common $ Preferred $ Provide all rights\and restricti staining to each class of sto~l~ \~ 5. Was the decedent emplo d by the Corporation? .... .... ...................... ^ Yes ^ N If yes, Position n I Salary a ev ed to Hess 6. Was the Corporation indebted to the decedent? . ....... .... ................ ^ Yes ^ No If yes,. provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the de of the deced t? ..... ^ Y s ^ No If yes, Cash Surrender Value $ Net pro eds pays $ Owner of the policy 8. Did the decedent sell or transfer an stock i his c pony w' hin one year pr' r to death or hi ears if the date of death was prior to 12-31-82? ^ Yes, ^ No If yes, ^ Tr sfer ^ S e Nu ber of Shares Transferee or Purchaser Conside tion $ Date Attach a separate sheet for additional transfers and/or sales. 9. ~Nas there a written shareholder's agreement in effect at the time of the d cedent's death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ..................................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, includ+ng dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE C-S PARTNERSHIP fNFORMATION REPORT ESTATE OF ~ ILE NUMBER 1. Narne of Partnership Date Business Commenced Address / Business Reporting Year City f State Zip Code 2. Federal Employer I.D. Number 3. Type of Business 4. Decedent was a ^ General ^ Limited 5. P ~ d USe ice was invited pa ner, pr d initial invest nt PARTNER NAME RCENIF ' 1NCQME RCE~1T O OWN$R 1~ ~. ~r - CA A! ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ G 7. Was the Partnership indebted to the decedent? .................. .......... .. ^ Ye ^ If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the If yes, Cash Surrender Value $ Owner of the policy the death f the decedents .. ^ Net procee payable ~ 9. Did the decedent sell or transfer an interes n this partn shi prior to 12-31-82? ^ Yes ^ No If yes, ^ ansfer ^ Sale Transferee or Purchaser Atiaci~ a separate sheet for additional transfers and/or sales. if the date of death was 10. Was there a written partnership agreement in effect at the time of the decec~nt's death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11// 11. Was the decedent's partnership interest sold? ..... . ................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •~ • ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. one year yfior to deatl~or within transferred/sold D. Any other information relating to the valuation of the decedents partnership interest. REV-1507 EX+ (1-97) ~~ ~> COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF _ ,~.-, FILE f ~ ~ ~ -, All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM I - NUMBER DESCRIPTION ~~ ~ ~ /~~ w~ VALUE AT DATE OF DEATH TOTAL (Also enter on fine 4, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-5508 EX * 11-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF . ~ FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM NUMBER Lam! ~~D/E~SC~R.fPTfON OF DEATH ~ <3" ! ~ ~ 3 0 6 ~. 7 O ~~ Cl~~r2~ ©cF ~-~ ~ rr~ v- TOTAL (Also enter on fine 5, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) X6.90 ~~o . ~ 731. ~"I REV-t5A9 EX. (t-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER ~ ~' ~~ ~ f ~~.1. ~ ~ /LSO - o~ " D7_ 6 Q~ 3 H an asset was made joint within one year of the decedents date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENAN'i DATE MADE JOINT SCRIPT N OF PROPERTY Includ ame of financial institution ba account number or similar identifying number. Attach deed or jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF ECD'S I REST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL. (Also enter on line 6, Recapitulation} ` ; (If more space is needed, insert additional sheets of the same size) REV-1510 EX .11-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF ~l ~ L ! FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OFTHETRANSFEREE,THEIRRELATICNSHIPTODECEDENTANOTHEDATEOFTRANSFER ATTACH A CCPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET °1o OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~. I~~~ TOTAL (Also enter on line 7, Recapitulation) I E (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) ~, SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSE5 $c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMC~ER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: p a ~ -c~va-r~ t e.'~-w j~ ~~" ~ ~~ .~1.° N~c,~~ 8 1 T,~t.G o ~-~ GQ..rTTe~s', S~ts~~` c2Q-7-~ ~ 1ST ADMINISTRATIVE COSTS:C~-.~ ~ ~-~ ~„~ ~~v V n/~, ~ i~1 T?' o.~i' ! ~C r° 1~ e-~ Personal Representative's Commissions ~v" i"O ^^ tFi"~ 23 ~ G~$-~ Name of Personal Representative(s) __._ ~_____~~?-~__.___...__________~. Street Address z City _~ ~o(~ l' ~-~- A-M~' C L ~ ~P„1' 12.-U`" State Zip ~? C..~~. Year(s) Commission Paid: _~ _ __( _ _ _~ _ _ ~_ _ Attorney Fees ~ d- -"<`~~'Te-L ~ ~//'}~-f4 Nb"t F`4'-C _~l ~ ~ ~- i Family Exemption: (If decedent's address ids not the same as claimant's, attach explanation} Claimant ,____ ___ Street Address City ------- ---. __- --~ State Zip -------- __--- RelaGonship of Claimant to Decedent _- ~ __ , __. _ ~~ 2. 3. 4. 5. 6. 7. Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation)1 $ ~C.a ~ (If more space is needed, insert additional sheets of the same size) REV•1~12 EX+ (12-03j COMMONWEALTH OF PENNSYLVANfA INHERITANCE TAX RETURN SCNEDt~LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS y~ F{LE NUMBER ~^,+ ESTATE OF f ~~ l ~ .~ l ~L~ " n /~~it' ~ ~D e~"B 7 ~ BT ~S 3 Report debts incurred by the decedent prior to dea-t'hCwlhic{hremained unpaid as of the date of death, inc/Ifud~ing unreimbursed medical expenses. ITEM I VALUE AT DATE NUMBEIR DESCRIPTION OF DEATH \, , r end ~- ~~ r ~ -v ~b~ d-~, lt3.a.~ TOTAL (Also enter on line 10, Recapitulation) 5 ~ 1 0 0 ~~~ I / (ff more space is needed, insert additional sheets of the same size) REV-151',3 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ~ FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under 1. Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-1500 EX Page 3 Decedent's Complete Address: File Number UtLtUtN I J NHMt i. STREET ADDRESS ~1 L-LY 6 ~ •I ~_~~~ _ - _ _ --- - - ~ t CITY .SON ~ - _~L ~-~ ~ , __J__ ~. ~ ~ I STATE ^~• ZIP ~ ~ ©~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ _ ___ __-- _-_ B. Prior Payments C. Discount Total Credits (A + B + C ) 3. Interest/Pe~nalty if applicable D. Interest E. Penalty - Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (2> (~ (3) (4) ~~ (5) ~~ A. Enter the interest on the tax due. (5A) (~ B. Enter thie total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ - c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of df;ath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §911E'~ (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate irnposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate irnposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate irrposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-151~I EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover Shei ESTATE OF ~ ~ / / FILE NUMBER L.L. y ~ t -r~.e~-- ~,~-. ~o . a~ - ®~ - 0 4~ This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE iS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table .............. .. ............................ . Interest table rate - ^ 3 1(2% ^ 6% ^ 10% ^ r' Rate ° 3. Value of {ife estate (Line 1 multiplied by Line 2 ........ .... ... ... .. NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH • NEAREST AGE AT DATE QF DEATH TERM OF YEARS ANNUITY iS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^SemI-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of pgriod, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+(~04) INHERITANCE TAX SCNEDt~LE L COM MONWEALTH OF PENNSYLVANIA INHERITANCE TAX flETURN AS P RESIDENT DECEDENT OR INV ON OF TRUST PRINC{PAL FILE NUMBER ~ , /V Q ,~ ~ "' ~ 7--D9 I. ESTATE OF (La Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) . B. Name(s) of Life Tenants} Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate ...............................$ 2. Stocks and Bonds .................. .......$ 3. Closely Held Stock/Partners ...............$ 4. Mortgages and Notes ............ .... .. ..$ 5. Cash/Misc. Personal Pro rty ......... ..$ 6. Total from Schedule L ............ ................................... ...$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ..................... ...$ 2. Unpaid Bequests ................... .: ... . 3. Value of Unincludable Assets .................$ 4. Total from Schedule L-2 ................................................... ...$ E. Total Value of trust assets (Line C-6 minus Line D-4) ...................... ....... ...$ F. Remainder factor (see Table I or Table II in Instruction Booklet) ........... .. .. ... .. . G. Taxable Remainder value (Line E x Line F) ............. .... ..... .... ... ..$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annwtant(s) corpus or annuity Is payable consumed C. Corpus consumed ......................................................... ...$ D. Remainder factor (see Table I or Table II in instruction Booklet) ...................... .. . E. Taxable value of corpus consumed (Line C x Line D) .............................. ...$ (Also enter on Line 7, Recapitulation) ~..; pEV.,~.S EX~ Ij_es' INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION ~~rr RESIDENT DECEDENT -ASSETS- FfLE NUMBER l~•a~" ~7 D~ I . Estate of ~„ ~- L~° %L_ (Last Name) (First Name) (Middle Initial) 11. Item No. Description Value A. Real Estate (please describe) To value f eal a to $ ' clude o coon C-1 o chedule L) B. Stocks d Bon please list Total value of stocks and bonds $ (include on Lin C-2 on c du L) C. Close) Hel' tock/Pa ship att Sch ul -1 a d/or C-2) (pleas li Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include` on Section II, line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total valve of Cash/Misc. Pers. Property $ (include on Section II, Line C-5 on Schedule L) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ b (If more space is needed, attack additional 8'/s x l l sheets.) REV-16415 EX+ (3-8d) ~` COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION I ~,q~ ~~~~7_~,~-3 -CREDITS- FILE NUMBER f ~~- / I ~ ~~ I. i Estate of [.~ (Last Na e) (First Name) (Middle Initial) lil. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) i J Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) thot are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ (If more space is needed, attach additional 8'/z x 11 sheets.) REV-1647 EX+ (9-00} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet ESTATE OF FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: N Summary of Compromise Offer: 'I. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4•. Value of Line 1 taxable at lineal rate Check One ^ 6°!°, ^ 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15°1°) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must squat Line 1) ..................... .$ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (11-99) SCHEDULE N _.,~. SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) INHERITANCE TAX DIVISION ESTATE OF ~ ~ ~ ~ FI E NUMBER This schedule m st be co pleted and filed if you checked the spousal poverty credit box on the cover sheet. 1 . Taxable Assets total from line 8 (cover sheet) ............................................ 1 . 2. Insurance Proceeds on Life of Decedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PAl_ottery Winnings ............................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Totail Actual Liabilities .............................................................. 8. 9. Net 'Value of Estate (Subtract line 8 from line 7) ........................................... 9. if line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1. TAX YEAR: 19 a. Spouse ........... 1a. b. Decedent .......... 1b. c. Joint ......... , ic. d. Tax Exempt Income .. 1d. e Other Income not listed above ........ 1e. f. Total ............. 1 f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: 3e. + (3f) (+ 3) 4b. Average Joint Exemption Income .................................................... . if line 4(b) IS Ofe9tBr than RdO.nnn - STAP Thu uchfn is nnf nGi.fi.le t,...~.,:.., ~r,.. ,.~,.,r.~ ~s __. ___..__. _ 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 2. Multiply by credit percentage (see instructions) 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet . .............................. . 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................ . 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet...... . 2c. 3c. 2d. 3d. ~ Part • 1. III. ~ 2. 3. 4. 5. iEV4849 E% • i1-37) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 0 ELECTION UNDER SEC. 9113(A) ESTATE OF FILE NUMBER Do not complete this sc edule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance ~ Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital residual A B By-pass Unified Credit etc ) If a trust or similar arrangement meets the regwrements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arran ement PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's Part B Total I (If more space is needed, insert additional sheets of the same size)